I had a request today from a 12 year old (accompanied by her mother). She presently wears one day disposables successfully but finds insertion a bit of a problem first thing in the morning.

Apparently a school mate of hers already has them! answer

What is your opinion on fitting a patient with silicone hydrogels for continuous wear if the patient is diabetic due to obesity and is not on any medication but is assessed regularly by his/her doctor? answer

Which cleaning regimen(s) do you recommend for silicone hydrogels, and which regimens, if any, are contra-indicated? answer

A patient is very pleased with N&D. White eyes, 8.40 better than 8.60 in contralateral trial and Rx -8.00 -6.50 R&L. Previous history low grade hypoxia with Focus and better with Dailies 7/7. Some Focus sols toxicity. N&D most comfortable etc etc no stain brilliant... Except they gum up between lens and eye with deposits nocte. Clear by morning and only way to see clearly in evening is to remove and clean (Opti-free express seems OK with no apparent allergic response). She loves the lenses, so do I, from her hypoxic history and D/W is obviously on at some cost but do you have any ideas. The deposits are greasy/oily, brownish under SL and stringy not mucin balls and no epithelial indentation, they disappear when lens is removed. Doesn't seem to need a rub just drop into sol, muck floats off and re-insert. Bit of a loss mate! answer

I have been wearing both the PureVision lens and the Night and Day lens to test them for myself. The Purevision is comfortable after cleaning, but the Night and Day lens is less comfortable. The Night and Day lens wears beautifully as a continuous wear lens, but, once it is cleaned apparently loses some comfort. Is there a reason behind this? answer

I have found the Ciba Nite and Day cl to be useful in managing patients with dry eye (used on a daily basis). Is cleaning i.e. Rub and rinse, with a one step solution recommended on these particular lenses? answer

In Dumbleton's editorial as well as the Optician article by Guillon and Maissa a distinction is made between rigidity and elasticity. My dictionary defines elasticity as flexibility and rigidity is lack of flexibility. Please explain the differences as applied to the properties of silicone hydrogels. answer

I fitted a patient with silicone hydogels recently. No problem at 24 hour visit. At 1 week visit patient was happy but I noted distinct SEALs in both eyes. Still noticable 24 hours later after removing lenses. I have discontinued her wear with this mode of lenses and returned to daily disposables for occasional wear. Patient was disappointed. Did I have any option? answer

What is the percentage of discontinuation due to SEAL and CLPC respectively? answer

Could switching brands of Silicone Hydrogel lenses avoid or reduce the recurrence of the above reactions? answer

Do you recommend refitting DW patients who have had inflammatory events such as IK, AIK or AI into CW? Would they be at greater risk for developing CLARE or CLPU? answer

Are there any topographical changes in the cornea with a well fitting silicone hydrogel lens? answer

Since the silicone hydrogel lenses are stiffer than a normal hydrogel how much astigmatism can be "masked" clinically with the focus day/night lens? answer

How often would you expect to see microcysts in the cornea of silicone hydrogel extended wear patients? answer

How do silicone hydrogels overcome the potential to be hydrophobic? answer

Do you recommend a daily flush of the eyes when using CW lenses? If necessary, what would you recommend flushing with? answer

I am a solo practice optometrist of 30 years with a moderate size contact lens practice. I have found success in reducing complication incidence with disposable soft lenses by emphasising the necessity for clean lenses and providing information on supplemental cleaning for those patients who will not be compliant with recommended disposable schedules. Due to the cost of silicone hydrogels I am having a problem compliance with monthly disposable schedule resulting in corneal complications assoiciated with soiled lenses. Is it possible to extend the lifespan of silicone hydrogels with supplemental cleaning? answer

What are mucin balls and are they of clinical significance? answer

Why should you not use low Dk/t soft contact lenses for extended wear. answer

Does continuous wear of silicone hydrogel lenses result in physiological changes? answer

Is continuous wear with silicone hydrogel lenses a viable alternative to refractive surgery? answer

Is there a difference between continuous wear and extended wear? answer

How much overnight corneal swelling do silicone hydrogel lenses produce? answer

What sort of adverse events occur with silicone hydogel lenses? answer

Because of greater price for CW lenses compared to DW to the patient, what would you suggest to a regular practice on how to approach patient with these type of lenses without having the usual "It's way too expensive" type of reaction from patient? answer

Is high molecular weight fluorescein necessary for testing with the lens on the eye, or do silicone hydrogel lenses not take up stain in the same way as HEMA lenses do? answer

Could you elaborate on the push up test, or give me an online reference? answer

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I have been fitting silicone-hydrogels (Purevision and Night and Day) for 5 years. Most of my px's wear them as 1 month extended wear. In this population, I have found many cases of peripheral infiltrates that may or may not have been sterile (I can't recall a single case in the daily wear population). Not all are symptomatic when I see them (ie. some are noted at routine follow-up), but when there are symptoms, the px invariably suggests that the problem started when "I got something in my eye". This almost universal description by px's suggests to me that the px may be correct. I believe that these inflammatory reactions, which may eventually lead to MK, are initiated by temporary insufficient replacement of the precorneal tear film under the CL. In practice, fitters may feel safe in fitting these lenses steeper than other CL's and certainly a Night and Day lens fit too flat is sure to cause lid awareness. However, the steeper fit may not allow adequate tear film renewal. I'm now considering recommending a non-preserved saline drop used BID for all S-H EW contact lens wearers. Is there any research to bolster my clinical impression?
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Following from the BCLA in 2004 there was suggested issues with the use of lens care solutions and silicon hydrogels. Indeed with Acuvue Advance certain sols are being strongly advised not to be used. Is there are new clinical evidence / publication which has looked at these new generation materials vs any new / existing solutions on the market?
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We have used the CIBA Night & Day lens very successfully in many patients, and it is the first lens I feel comfortable suggesting overnight wear to patients.  We have had three patients this year, however, who have come in (all three were new patients) with signs of hypoxia secondary to soft CL overwear.  After refitting these three in the Night & Day, the cornea has decompensated to varying degrees.  The most severe case was in a 60 yr old moderate hyperope who had been wearing her previous non-disposable lenses on an extended-wear basis for over a year.  Her corneae developed obvious edema, striae and bleb-like opacities on the endothelium.  This slowly resolved after discontinuing the lenses.  We have resumed daily wear in an Acuvue 2, and the problem is continuing to resolve.  The other two patients exhibited milder signs, but that may have been because we were aware of the problem and stopped the overnight wear.  We consulted our corneal specialist at the school, and he could not come up with a good reason the cornea would break down in the presence of more oxygen.  It did not seem like an allergic reaction.  I was wondering if any of you have come across this apparently atypical reaction. 
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I have a 15 year old patient who plays competitive water polo and spends nearly every day wearing contact lenses in a chlorinated swimming pool. Although I recommended swimmng goggles he prefers not wearing any, and he and his coach were wondering what contact lens material would minimize chlorine uptake. He has been wearing Acuvue 2 contact lenses, and I am having him try Acuvue Advance contact lenses. Would the chlorine uptake in water, and from chlorine gas above the water, be any different in Acuvue Advance or another silicone hydrogel than a HEMA contact lens?
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An existing extended wear px of mine has just been diagnosed as diabetic ,this px is 30 yrs old. I would normally not fit diabetics with extended wear contact lenses, however this px has been told by the hospital that they are still fine for him. Please advise me of your opinions on this.
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After having successfully fit well over 300 patients in silicone hydrogels since mid January I have noticed that mucin ball formation is rarely seen in my daily wear patients(ava) and often seen in extended wear (fnd). Is this due to extended wear or higher amounts of silicone? Also many patients with focus night and day (fnd) seem to need longer trial periods to decide if they like the lens(most of whom do). Is that because their corneas are still going through rehab? Next I have had about 8 to 10 acuvue adv. pts. switch back to previous lenses after a couple months any ideas? most of them just said comfort decreased after a few pair. thank you for your time. ps I am getting Better than 90% success with silicone hydrogel lenses.
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I would like to thank Dr J Smythe for her interesting article on the Piggy back solution I have many patients that have been hacked by refractive Surgery and are always a challenge to refit with contact lenses 3 questions can you use this system on patients who have undergone RK and lasik in the same eye is neovascularization a sight threating risk for post op RK patients using soft contact lenses could you please explain more specifically the method for selecting base curve of the rigid contact lens for the piggy back system. answer

I know that use of fluorscein is ok with SH lenses. Does the surface treatment on these lenses have any affect on their absorbtive properties, i.e., use of ocular med's for treatment of glaucoma? Are they any less likely to absorb pharmeceutical drops than conventional hydrogel lenses? answer

Could the panel please tell me the current research rate for microbial keratitis for the following modalities?

a) daily wear monthly disposable
b) continuous wear monthly disposable
c) daily wear contact lens answer

Which is the pore size of Focus N-Day and Purevison ? answer

Are there any problems with heat disinfection with non-preserved saline? answer

Secondly, can patients swim in these lenses? answer